3. BATHS, AND HOW TO TAKE THEM. i BY MISS HARRIET N. AUSTIN, M.D. 24* BATHS, AND HOW TO TAKE THEM. BY MISS HARRIET N. AUSTIN, M.D. To many persons the descriptions and explanations below may seem unnecessarily minute, but they will not, I think, to him who has had much experience in giving instructions for home-treatment. He who has seen persons attempt to take sitz-baths in wash-bowls, to take half-baths without undressing, to give a dripping-sheet by wetting one corner of the sheet in cold water, or to give hot fomentations with a small linen towel, or a bit of flannel as large as his two hands, has learned how crude are the notions of the people in regard to the whole matter of water-treatment. A vast deal of injury has been done in this method of treatment, as well by the bungling use of ap- pliances, which, if skilfully used, would have been entirely proper, as by the use of such as were wholly unsuited to the person to whom they were administered. We do not give heroic treatment. We do not believe in it. Our baths are all mild, and given at not very frequent intervals. The first thing to be done when a bath is to be given, is to prepare the room, making it a comfortable temperature. The second is to prepare the bath, using soft water, and making it of the right temperature, as indicated by a thermometer. Persons sometimes ask us to explain what we mean by certain temperatures, so that they can get along without a thermometer. This is impossible. The terms hot, cold, warm, tepid, are so indefinite, and convey so different impressions to different persons, as to be entirely unreliable in giving directions. What is hot to one person is cold to another, in the morbid states through which sick persons pass. And the sensations of healthy per- sons arc so variable, that they cannot be relied upon to temper baths  4 BATHS, AND HOW TO TAKE THEM. by the touch for those with whom a slight change is of conscquonco. Of course the line where cold passes into tepid, or tepid into warm, is inappreciable, but in general terms I should consider a bath at 75° Fahrenheit, cold ; at 85°, tepid ; at 95°, warm ; and at 105°, hot. The idea that the hotter a person is the colder should be his bath, is productive of great mischief. The true rule is exactly the reverse of this. That is, a person in a high fever should have his bath at a higher temperature than if he had no fever ; for what, in the latter case, would be a pleasant temperature to him, might be shockingly cold in the former. So, while, in such conditions, a bath at 90 y would subdue the fever, one at 75 y would be likely to produce violent reaction, and in half an hour the fever would be higher than before.* Having the bath ready, the next thing is to get the patient ready. One who is suffering from acute disease may often, when feeling ner- vous and restless and exhausted, be greatly refreshed and soothed by the administration of a bath. But persons who are taking a course of treatment for chronic ailments, or those who simply bathe for cleanliness, should never take their baths when tired. Baths are always most beneficial in their effects when taken with the body at its highest point of vigor. Hence, as a rule, ten or eleven o'clock in the day is the best hour for bathing. When this is impracticable, the hours of rising or retiring are unobjectionable. No bath should be taken immediately after or before a meal. Care should be taken to have the feet warm on coming for a bath. In cases where they are habitually cold, and cannot be warmed by exercise, it is often well to take a warm foot-bath, for a few minutes, before a general bath or a pack. Next, the patient lays aside all his clothing, and wets his fore- head and top of the head in the bath or cool water ; and if the bath is continued beyond a few minutes, like a sitz-bath, a wet towel or cap should be kept on the he id. If the bath is to be reduced, as wo very frequently do, as reducing a half or sitz-bath from 90° to 85° or 80°, the patient rises out of the water while the attendant pours in cold water. Soap should never be used except for persons who bathe very seldom, or who are very dirty. When a person comes from any general bath, that is, having the whole surface bathed, he should be instantly enveloped in his wiping -sheet, and himself and the attend- * If a person in fever is to be packed, his conditions are much more readily and safely controlled by wetting two sheets in water at 90°, wringing them but slightly, packing him in them, or even by putting him into a fresh pack when the first one becomes heated, than by putting him into a cold sheet. BATHS, AND HOW TO TAKE THEM. 5 ant should fall to rubbing vigorously. Sheets should be made speci- ally for bathing purposes. A common cotton bed-sheet will answer for wiping ; for a sheet of some kind must be used, towels after a general bath being entirely unfit, and crash towels quite out of the question. But for 'packing or dripping-sheets, use linen, and have the sheet not longer than to reach from the person's head to his heels. The fabric may be coarse and heavy, but must be soft and smooth. As soon as the skin is thoroughly dried after a bath, the sheet is removed, and the rubbing continued briskly and gently over the whole surface, with dry hands, for four or five minutes. A healthy person can do his own rubbing, but the invalid is greatly benefited by having an assistant. And everything that this person has to do in administering the treatment should be done with energy and ex- pedition, not leaving the patient in a shivering, uncomfortable state, for even the shortest length of time. After getting through with the bath, immediate means must be taken to establish thorough and permanent reaction. If the person has a good degree of strength, he may go out, well dressed, for a brisk walk, or to split wood, or fodder the cattle, or do anything which will keep him stirring. But in the case of very delicate per- sons, it is often better, particularly if the weather is inclement, to go to bed, well covered up with a cool cloth on the head, and a warm blanket at the feet, if needful, and lie for an hour or two, till the circulation becomes entirely quiet. And sometimes comparatively strong persons do well to follow this course, and get up and take their exercise afterward. If a person uses these means, and still grows chilly thirty or sixty minutes after his bath, or if after an hour or two he feels an unusual languor or exhaustion, his bath has done him harm instead of good. GENERAL BATHS. The IIalf-Bath, so called because about half the person is im- mersed in water, is taken in a tub about four and a half feet long, twenty-six inches broad toward the widest end, and gradually tapering till it is no more then fifteen inches broad toward the other end, and eleven or twelve inches high. At least, this is a convenient size and shape. Ours are made with staves and hoops, and sit on wooden horses about twenty inches high, with a hole, stopped with a plug in the bottom, at the small end. The bath is prepared at the right temperature, about six inches deep : the patient wets his head and steps into it, sitting down in the broad end of the tub, with his feet 6 BATIIS, AND I10W TO TAKE TIIT.M. extended toward tho narrow end. To have it done jusl right, there should be two attendants ; one to rub the patient's legs, and tho other to rub his back and arras, while he rubs the front part of his body. The rubbing should be done lightly and briskly, dipping the water up on to the body with tho hands very frequently. Tho common time to continue the bath is for two minutes, though, to gain a particular end, it is ofton continued much longer. In an institution where all the apparatus is at hand, this is one of the most convenient, pleasant, and efficient forms of bath. The Plunge is taken in a tub four or five feet deep, nearly filled with water, and so narrow that the person can place a hand on each side of the tub, leap in, crouch down till the water rises to his chin, and then leap out. This is a very pleasant, and, if taken cold, a very exhilarating form of bath. When arranged, as wo have it at Our Home, so that the temperature of the water can be raised to about 75° or 80°, it is one of the best baths which a robust, healthy person can take for cleanliness, daily or tri-weekly. The Dripping-Sheet will, perhaps, be found to be more practicable for invalids in families than any other form of bath. It requires but little water, can be taken on the nicest carpet, and, if mild in its tem- perature, produces very mild reactions. An oil-cloth should be spread on the floor or carpet, and the sheet put in a pail half full of water. The patient stands in the middle of the cloth, and the attendant raises the sheet by two of its corners and throws it around him, so as to completely envelop him from his neck to his feet, and immediately falls to rubbing him vigorously with both hands, over the sheet. If desired, the sheet can be partly relieved of the water by squeezing through the hand, as it is raised from the pail. It is common to ap- ply the sheet twice ; first in front, lapping it behind, rubbing one minute, then removing, dipping in the water again, and putting around from behind, and rubbing another minute. A very feeble per- son can take this bath sitting on a stool, if need be ; but in that case there should be two persons to rub outside the sheet. Or a strong person can take it alone, as he can reach nearly every part of his per- son to rub, and can wash his back by drawing the sheet across it. It is an excellent bath. The Pail-Douche should be taken in a room where a portion of the floor is lower than the main part, and from which the water is carried off by a drain. From one to six pails full of water may be used. The person stands on the depressed floor, and the attendant, standing four or five feet away, takes up a pail and dashes the water BATHS, AND HOW TO TAKE THEM. 7 with considerable force, at three or four dashes, over him, letting it Btrike near the upper part of the body, and so run down and cover him ; the recipient meantime turning slowly round, so as to receive the water on all parts of the body. This is a very pleasant bath, if not taken below 80°, and entirely unobjectionable to be used daily for cleanliness by persons in health. The Towel - Washing has no advantages over the dripping-sheet, ex- cept in instances where it is used simply for cleanliness and is more convenient, or where the person is too feeble to sit up. One who is very feeble may be bathed in this way without fatigue or exertion. The nurse uncovers an arm, or a leg, or a small portion of the body at a time; partially wrings a soft towel out of tepid water, and washes the part quickly and gently ; wipes with a soft towel ; rubs with the warm, dry hand; covers again; and so proceeds till the whole surface is washed. Or, if this is too much at one time, the operation may be suspended an hour or two. Patients who are fever- ish are often greatly soothed and comforted by having the back bathed in this way several times in a day, or even by having the face, hands, and feet bathed. Water may be used more freely by spread- ing a dry sheet or blanket under the patient, to protect his bed. If the patient is able to get up for his bath, the dripping-sheet should be used instead of a towel. THE PACK. Preparation is made for the Pack on a bed or lounge, the pillow lying in its place, and two warm comfortables and a woollen blanket, or as many blankets as will amount to these in quantity, being spread outside. Over these is spread the wet sheet, slightly wrung, and so high up that it will reach but a few inches below the knees, and may be wrapped around the head. The patient immediately places him- self upon this, on his" back, his arms at his sides, and the attendant quickly brings the corner of the sheet over from the farther side, un- der the chin, and tucks it under the near shoulder, and up close to the neck, and then all along down the body to the bottom of the sheet. Then the opposite side of the sheet is spread over and tucked under in the same way ; then one side of the blanket, then the other, and so of the comfortables, being sure to make these snug around the feet. If there is liability that the feet will grow cold, they should be wrapped in a warm blanket, or have a bottle of hot water placed near them, outside the blanket. Sometimes we wTap them in flannel, folded and wrung out of hot water ; and very fre- 8 BATHS, AND HOW TO TAKE THEM. quently, when persons have local congestions, as of the lungs, liver, or throat, we place over the part hot, wet flannels -when we put them in pack. I have known persons, who could not take a pack in the ordinary way without chilling, have them administered with great benefit by placing a strip of hot flannel up and down the back- bone, inside the wet sheet. A cool, wet towel should be laid on the forehead, and the person left entirely quiet, and in three times out of four he will go to sleep and get a delicous nap. lie should not bo left alone, however, unless he is accustomed to it, as he may become very nervous on finding himself alone and helpless. The rule for re- maining in the pack, if the patient iB quiet, is till he feels thoroughly warm ; say from twenty-five to sixty minutes. It is usual to give persons some form of general bath, as described above, the moment he is taken out of pack ; though with feeble persons we sometimes throw the dry sheet round them instead, and wipe immediately. „ Or such one may take a towel-washing, lying still, and being only partly un- covered at a time. LOCAL BATHS. The Sitz-Bath may bo taken in a common-sized wash-tub, though we have tubs made on purpose, which are higher at the back, with so much water as nearly to fill the tub when the person sits down. The person should remove all his clothing, except his shoes and stockings, and be well wrapped up in his bath with a comfortable. Many times it is desirable to undress the feet also, and take a warm foot-bath while a tepid sitz-bath is taken. In this case, the feet should be dipped into the cool water when taken out of the warm bath. A cool, wet cloth or cap should be worn on the head. This bath is continued from five to ninety minutes, to meet conditions ; though the more usual time is from fifteen to thirty minutes. The Shallow-Bath may be taken in any tub sufficiently large to allow the person to be immersed in water to the hips, as he sits or stands in it. The upper portion of the body should be covered with a blanket or warm wrapper. This bath is continued from five to thirty minutes. Sometimes, however, it is taken sitting, in a half-bath tub, an attendant rubbing the limbs, and in such case it is continued from one to five minutes. The Hand- Washing is performed by dipping the hands frequently in a vessel of water, and rubbing vigorously a limited portion of the surface, as over the chest, abdomen, liver, spleen, or spinal column. Severe congestions are sometimes relieved by this process — dipping BATHS, AND HOW TO TAKE THEM. if the hands alternately in cold and hot water, and continuing it ten to twenty minutes. Foot-Baths are made from one to five inches in depth, in a keeler or common pail, and are continued from five to twenty minutes. Hand-Batus taken alone, or with foot-baths, are often beneficial. When Fomentations are to be applied to any part of the trunk of the body, the better plan is to double a woollen blanket and spread it in a bed, and let the patient undress and lie down upon it. A flannel folded to about six thicknesses is then wrung out of hot water, and placed upon the part to be fomented ; the blanket is brought over it, first from one side and then the other, and then the bedclothes spread over all. The cloth should be applied at such a temperature as to feel decidedly warm, or pleasantly (not unpleasantly) hot ; and should be replaced by a fresh one as often as it grows cool — say from six or eight to twelve or fifteen minutes. The head must be kept cool and the feet warm. The applications may be continued from ten minutes to two hours, as occasion requires. On finally removing the flannel cloth, the part fomented must be washed off with cool water — say at 85° or 80° — unless a cool bath is to follow, or a cool bandage or compress is to be applied. Here is an important point. Whenever water is applied to any part, or the whole, of the body at so high a temperature as to relax the coats of the capillaries and distend them with blood, it must be followed by an application at so low a tempe- rature as to constringc the vessels and restore their tone. Otherwise there is great liability to take cold. Hence the old-fashioned way of " soaking the feet in hot water," on going to bed at night, for a cold, had to be done with great care to avoid adding to the cold. If the hot bath had been followed by a cold one, there would have been no difficulty. SWEATING. One of the most convenient and efficient methods of inducing sweat- ing is to place the patient in a sitz-bath, with a foot-bath, letting both be as warm as can well be borne. He must be well covered with a comfortable, and as the baths gradually cool, hot water can be added. The head must be kept well wet with cold water, and watch kept that the patient does not grow faint. When perspiration is thoroughly established, he may take a half-bath or dripping-sheet, and go to bed. If it id desired to check the perspiration entirely, a good way is to commence the half-bath as high as 90°, and gradually reduce it to 80°, or lower. One of the safest and most effectual modes of break- 25 10 BATHS, ANT) HOW TO TAKE THEM. ing up a severe cold, for a robust person, is to place him in the hot- bath till he sweats profusely, and then transfer bin i mme d i ately to a pack at about 80°, and follow this by a dripping-sheet, ami Bend him to bed, with but little to eat for two or three days. If then El congestion of the throat or lungs, it is sometimes well to foment tho parts while in the hot-bath. Such a course as this is a considerable tax upon the strength, and should be followed by, at least, several hours' repose in bed. If, after gorhg to bed, tho sweating continues too long, it should be checked by a cold bath ; or, if it continues at all, it is well to rub off the surface with a wet towel on rising. EMETICS Of warm water should be administered at the temperature most sick- ening to the patient, probably about 90°. Tho draughts should be taken at short intervals, not allowing time for tho absorbents of the stomach to take up the water to any great extent. It may be need- ful to give anywhere from a pint to four quarts. INJECTIONS, When used daily for cathartic purposes, should be taken at a regular hour, one hour after breakfast being a very suitable time, at a tempe- rature of 85° or 80°. If there is particular inactivity of the bowels, the enema may be rendered more efficacious by lying down, having the water slowly injected, and retaining it fifteen or twenty minutes, if necessary, for this purpose pressing externally with a folded towel. Some author has said, that it is better to lie upon the right side in tak- ing an injection ; and it would seem, from the conformation of the intes- tines, that there might be reason in this. Where there is obstinate constipation, it is sometimes useful to take a small cold injection, to be retained on going to bed at night. BANDAGES, To be worn next the body, should be made of heavy, soft linen. The outer, dry bandage may be made of common cotton muslin, cotton jean, cotton flannel, or, if necessary to keep the person warm, woollen flannels. Both the outer and inner bandage should be made double. The rule for wetting the bandage, in chronic ailments, is before it gets dry —say three to five times in twenty-four hours. In acute dis- BATHS, AND HOW TO TAKE THEM'. 11 eases, particularly if there is much fever, they may need wetting much oftener. It is not necessary that they should be -wet in very cold water if this is unpleasant, but the water should be cool. Abdominal Bandages may be made about six inches wide, and suf- ficiently long to wind twice around the body, or only long enough to pass around the body once, and meet in front. In the latter case they should be wide enough to cover the stomach and abdomen, and need to be fitted to the form, by inserting gores in the lower part, or taking seams in the upper part. The Wet-Jacket is fitted nicely to the form, having armholes, and coming up snugly round the neck, and may reach only to the waist, or it may come to the hips. In this form they are admirable, worn in fevers. They should be made to lap in front, thus covering the chest with four thicknesses of wet linen and of dry cotton. These, as well as the abdominal bandages, may be left dry across the back, if they cause chilliness. In both cases, also, the outer bandage should extend a little over the edge of the wet one. The Throat-Bandage should be about three inches wide, and made to pass once or twice around the neck. Compresses are limited bandages, as a folded wet towel, worn over the throat or chest or stomach or liver, and so covered with a dry bandage as to be kept warm. THE WET CAP Is made by taking a piece of linen long enough to measure round the head, just above the ears, and from three to four inches wide when doubled. This is sewed together at the ends, and gathered at the up- per edge into a round crown piece. It is wet in cold water, and worn on the top of the head, coming down on the forehead, and must be re-wet as often as it becomes dryish. It does not add particularly to the attractiveness of one's appearance, but is exceedingly comfortable where one suffers from heat in the head, from chronic congestion, or to be worn in the study or library when thinking is not easy.